In 2025, the outpatient reimbursement policy in Xilinguole League (XLGL) has several key highlights. For outpatient examination fees in primary medical institutions, the reimbursement ratio for 11 types of fees such as general outpatient examination fees and emergency examination fees for urban employees and urban and rural residents has been adjusted to 100%, with no deductible line, meaning patients don't need to pay for these fees personally. In addition, the outpatient co - ordination policy for employees has been adjusted in terms of deductible standards, reimbursement ratios, and maximum payment limits, while the outpatient reimbursement policies for urban and rural residents also vary according to different situations. Here is a detailed breakdown:

1. Outpatient Examination Fees in Primary Medical Institutions

Since July 2023, the reimbursement ratio of 11 types of outpatient examination fees (registration fees) for urban employees and urban and rural residents in township health centers and community health service centers in XLGL has been adjusted from 80% to 100%, and single - line payment is continued without a deductible line. These 11 types of fees include simple and convenient outpatient examination fees, emergency examination fees, general outpatient examination fees, outpatient examination fees for associate chief (associate professor) physicians, outpatient examination fees for chief (professor) physicians, general outpatient TCM (Mongolian medicine) syndrome differentiation and treatment, outpatient TCM (Mongolian medicine) syndrome differentiation and treatment by associate chief (associate professor) physicians, outpatient TCM (Mongolian medicine) syndrome differentiation and treatment by chief (professor) physicians, outpatient TCM (Mongolian medicine) syndrome differentiation and treatment by national TCM masters, emergency TCM (Mongolian medicine) syndrome differentiation and treatment, and Internet follow - up visits.

2. Employee Outpatient Co - ordination Policy

• Deductible Standard Adjustment (since January 1, 2024)

• For 在职 employees, the annual deductible standard for policy - compliant medical expenses in general outpatient co - ordination has been adjusted. For tertiary, secondary, and primary and below - level designated medical institutions, it is 500 yuan, 300 yuan, and 200 yuan respectively, and the deductible standard is calculated on an annual basis, with a maximum not exceeding 500 yuan.

• For 退休 employees, the annual deductible standard for policy - compliant medical expenses in general outpatient co - ordination has been adjusted. For tertiary, secondary, and primary and below - level designated medical institutions, it is 300 yuan, 200 yuan, and 50 yuan respectively, and the deductible standard is calculated on an annual basis, with a maximum not exceeding 300 yuan.

• Reimbursement Ratio and Maximum Payment Limit

• The reimbursement ratio and maximum payment limit for employee medical insurance general outpatient co - ordination remain unchanged. Within a natural year, after the outpatient expenses of insured employees reach the deductible standard, the payment ratio for tertiary - level designated medical institutions is 65% for 在职 employees and 70% for 退休 employees; for secondary and primary and below - level designated medical institutions, the payment ratio is 80% for 在职 employees and 85% for 退休 employees. The annual maximum payment limit is 5000 yuan for 在职 employees and 6000 yuan for 退休 employees.

3. Outpatient Reimbursement Policy for Urban and Rural Residents

• General Outpatient

• When insured residents seek medical treatment at township - level and village - level designated medical institutions, the medical expenses are limited to 100 yuan per person per year. For a single - visit medical expense that meets the regulations, the township - level designated medical institutions pay at a ratio of 50%, and the village - level designated medical institutions pay at a ratio of 60%.

• Since July 2023, the reimbursement ratio of 11 types of outpatient examination fees (registration fees) for urban employees and urban and rural residents in township health centers and community health service centers has been 100%, with no deductible line.

• Outpatient Chronic Diseases

• There are 30 types of diseases such as aplastic anemia and chronic renal failure, with a reimbursement ratio of 70% and an annual payment limit of 3000 yuan.

• There are 18 types of diseases such as liver cirrhosis and connective tissue disease, with a reimbursement ratio of 60% and an annual payment limit of 1800 yuan.

• For pulmonary arterial hypertension, the reimbursement ratio is 75%, and the annual payment limit is 100,000 yuan.

• Outpatient Special Diseases

• For diseases such as outpatient treatment of malignant tumors, anti - rejection treatment after organ transplantation, and chronic renal failure (hemodialysis), the reimbursement ratio refers to the local inpatient payment policy in XLGL, and the annual maximum reimbursement limit is calculated together with the annual inpatient maximum payment limit.

• Outpatient Special Medications

• For urban and rural residents, the deductible standard for outpatient special medications in tertiary hospitals is 600 yuan, and in secondary hospitals, it is 400 yuan; the payment ratio is 70% in tertiary hospitals and 75% in secondary hospitals. The payment for outpatient special medications is included in the annual maximum payment limit management of the whole league.

In general, the 2025 outpatient reimbursement policy in XLGL is designed to better meet the medical needs of different groups, improve the utilization rate of medical resources, and reduce the medical burden on the masses. When seeking medical treatment, it is recommended that insured persons understand relevant policies in advance and keep relevant medical receipts and certificates to ensure smooth reimbursement.